Follow up:
The patient was followed-up every 4–6 months for around 10 years.
During this period, her overall periodontal condition was stable, and
routine maintenance was performed. Although few incidents of disease
exacerbation with PDs of approximately 4–5 mm around the molars
occurred, local nonsurgical measures were sufficient for their
management (Figure 3). During that period, the patient developed type 2
diabetes mellitus and hypertension. Towards the end of the nineth year
after surgery the patient was diagnosed with breast cancer for which she
underwent resective surgery and received hormonal treatment and
bisphosphonate injections. The patient could not adhere to the
periodontal maintenance program during this period and missed multiple
appointments. Consequently, her oral hygiene reduced, and the
periodontal status began to deteriorate. PD around tooth #16 increased
and arresting disease progression was difficult. Around four years
later, the patient finished her breast cancer treatment and resumed her
dental visits; PD around tooth #16 had significantly increased up to 9
mm, and surgical intervention was necessary. Cone-beam radiographic
evaluation revealed bone loss around the tooth, and extraction and
implant placement were planned (Figure 4). However, the tooth was in
function and had successfully preserved the space for approximately 14
years.